JOEYELL  CHESTNUT

Currently, working in the Decision Review Operations Center (DROC) as a Veterans Service Rep. for VA Claim Appeals conducting analysis related to claims development errors remanded by the Board of Veterans Appeals (BVA) and the VBA’s Decision Review Officers (DRO).

Processing claims regarding Remands, High-Level Review, or Supplemental due to VA error as it relates to the VA’s Duty to Assist requirements. Review and respond to congressional regarding the Veterans claim status or any issues. Military Sexually Trauma Subject matter expert.

For Fiscal Year 2023, Claims processing standards were 96.4% for the Quality Product rate with a 2.6% error or request for corrections by the VBA Quality Control Team.

Process more claims than required by the VBA by 239 points which is considered Exceeding Quality Standards as on only 311 points required to meet the basic claim processing standards.

Extensive background in researching federal regulations and procedures to ensure compliance with Congressional mandates and laws.

Ensure Veterans’ claims are processed based on the required remand instruction to reduce or alleviate further errors related to the Veterans claim process.

Contacting Veterans on a daily basis via mail or telephone to discuss claims process or to gather subsequent evidence required by the BVA or DRO via an online telephonic system Cisco/Jabber.

Making determinations as to the eligibility for the type of benefit sought to include questions relating to adequacy of military service, medical evidence, and the evaluation of evidence of income, employability, dependence, and relationship based on the requirements of the Code of Federal Regulations Title 38 Pensions, Bonuses, and Reliefs (eCFR), M21-1 Adjudication Procedures Manual, M21-4 Manual for Appendixes and Chapters, and the M21-1 Appeals section.

Utilizing various VA electronic data processing (EDP) systems to process Veteran benefit request for Compensation and Pension claims for VA benefits which includes: Veterans Benefits Mgmt. System (VBMS) Awards(VBMS-A), Defense Personnel Records Information System (DPRIS), VA Records Mgmt. Center (RMC), NPRC (PIES), CAPRI-Enterprise Search Engine, Joint Longitudinal Viewer, (JLV), VISTA, Veterans Information Solution (VIS), DOMA, SHARE, Veterans Appeals Control and Locator System (VACOLS), LEAF-Overtime Pay System, Workload and Time Reporting System (WATRS), Caseflow-eFolder Express system, and a multitude of third party systems designed to help the Veterans claims process.

Processing daily approximately 8-11 Veteran claims pertaining to initial/original claims, service-connected increase claims, individual unemployability claims, and denied claims for remanded contentions.

Using VA systems like VBMS, Letter Creator, Exam Request Builder (ERB), and CAPRI to process correspondence required to complete claim request or to request Veteran medical or military records for Federal, Non-Federal, and 3rd Party Shareholders.

Requesting approximately 15-20 examinations, re-examination, or medical opinions to evaluate disabilities resulting from diseases or injuries.

Reviewing claims or cases to assure all issues have been addressed, applied, and interpreted IAW VA laws, including veterans' case law, existing statutes and procedures, precedent rulings, and state law in the adjudication process.

Conducts informational interviews by phone with veterans, representatives, and advocates to explain the full range of VA benefits and related programs.

Prepares and releases correspondence for use by other federal, state, and local agencies.

Completed VIP-IWT Training with a 96% processing average on all assigned training modules and assessments use to train new VSRs how to complete claims adjudication procedures related to Veteran Disability and Compensation or Appeals request.

Worked daily to ensure effectiveness of local business. Utilized Quick Books software, in conjunction with Freshbooks, to ensure accurate payroll and accounting; Provided written and oral communications skills to provide clients with services offered as well as billing options. Worked with other companies in the area to provide referrals for services we couldn’t accommodate. Maintained regular contact with customers to ensure satisfaction. Maintained new clients, including site surveys. Ensure all federal, state, and local business and labor laws, as well as occupational safety regulations, were followed.

Investigate, evaluate, dispose and settle less complex claims under close supervision. Includes, but not limited to, the investigation, determination and evaluation of coverage, liability and damages and the setting of proper reserves. Have obtained all initially required licenses, and work at a full caseload capacity. Interface with and obtain information from claimants, clients, vendors and other resources. Daily review and analysis of regulations and data to extract appropriate information from them for award or denial of claims. Conducted investigations, appropriately document information, evaluates losses and exposures and recommends appropriate settlements to conclude claims. Analyze and evaluate various coverage, exposure and damage issues. Maintain effective and ongoing communication with various internal and external contacts both orally and in writing in a clear and logical manner with individuals from a variety of backgrounds. I am proficient in Microsoft Office and several computer Software and Automated Systems to handle claims. I have successfully worked independently and in a team environment daily to establish priorities and organize work to close claims in a prescribed time limit. Each day I am responsible for determining my priorities, balancing successfully conflicting demands as they arise. On each claim that I process I had to present in writing the problem and how it was resolved and what was the claim outcome. Special Project Assignment DBA Defense Base Act Claims, prior military and other personnel working under contract on U.S. Military Bases, or any land used by the U.S. for Military purposes. Once the claim was reported, contact was made to the claimant by oral or written communication. After full investigation and reasoning with the claimant a decision would be made regarding the claim.

As a Workers Compensation Assistant, the clerical and administrative duties I performed were, phone calls, handle walk ins, pulling monthly reports, attend off site meetings and take applications from coal miners/widows, explain the rules and regulations with miners/widows, set up direct deposit, change address, medical scheduling-follow up if appointment made and kept. Make sure all medical records are on file and kept in a filing system, send medical releases and request for prior records pertaining to the lungs, prep file for Administrative Law Judge, prep file for validation review by physician (reading of x-rays), death match request statement of death (721) form from funeral home or family, Rep payee paperwork to set up miner or widow payee, initial development of the miners file, request history of earnings from Social Security, review pulmonary test results, use of Rules and Regulations, HIPAA Privacy Laws, reschedule miners medical exams, income verifications, X-Rays logging and tracking, conversions, breakdown of files from Administrative Law Judge, medical development to physician with HCFA 1500 with correct CPT codes and (ICD-9) Diagnosis codes, follow up with physicians via phone calls, logging medical tests into spreadsheets, use of physicians curriculum Vitae. E-Medical scheduling is used to get faster appointments. I am proficient in Microsoft Office and several computer Software and Automated Systems to handle claims. I also created, organized and filed documents in each file as we received them. Daily I read, interpret and analyze regulations and data to extract appropriate information from them for award or denial of claims. Preparing reports and in different formats using different types of information. Keep an appointment calendar. Maintain effective and ongoing communication with various internal and external contacts both orally and in writing in a clear and logical manner with individuals from a variety of backgrounds. Explain and interpret the administrative policies and procedures. Communicate in writing to get information that is needed and present the information. I have successfully worked independently and in a team environment daily to establish priorities and organize work to close claims in a prescribed time limit. Each day I am responsible for determining my priorities, balancing successfully conflicting demands as they arise. On each claim that I process I had to present in writing the claim problem and how it was resolved and what decision was made at that time.